Provider Demographics
NPI:1821594987
Name:HAVRILA, CAROLE JUNE (RD, CSO)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:JUNE
Last Name:HAVRILA
Suffix:
Gender:F
Credentials:RD, CSO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 LEE ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-0817
Mailing Address - Country:US
Mailing Address - Phone:434-243-9627
Mailing Address - Fax:434-243-2673
Practice Address - Street 1:18 SPRING OAKS LANE
Practice Address - Street 2:
Practice Address - City:RUCKERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22968
Practice Address - Country:US
Practice Address - Phone:434-465-0899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00722000133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered